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Background: Compassion is seen as a core professional value in nursing and as essential in the effort of relieving suffering and promoting well-being in palliative care patients. Despite the advances in modern healthcare systems, there is a growing clinical and scientific concern that the value of compassion in palliative care is being less emphasised.

Objective: This study aimed to explore nurses’ experiences of compassion when caring for palliative patients in home nursing care. Design and participants: A secondary qualitative analysis inspired by hermeneutic circling was performed on narrative interviews with 10 registered nurses recruited from municipal home nursing care facilities in Mid-Norway. Ethical considerations: The Norwegian Social Science Data Services granted permission for the study (No. 34299) and the re-use of the data.

Findings: The compassionate experience was illuminated by one overarching theme: valuing caring interactions as positive, negative or neutral, which entailed three themes: (1) perceiving the patient’s plea, (2) interpreting feelings and (3) reasoning about accountability and action, with subsequent subthemes.

Discussion: In contrast to most studies on compassion, our results highlight that a lack of compassion entails experiences of both negative and neutral content.

Conclusion: The phenomenon of neutral caring interactions and lack of compassion demands further explorations from both a patient – and a nurse perspective.

Background:Within the psychiatric inpatient care in Sweden, about one in five patients are cared for against their will, according to the Act on Psychiatric Forcible Care (LPT). Suffering from mental illness and being subjected to obsessive-compulsive care is a life-changing event for patients. It is desirable to improve coercive care and reduce the incidence of coercive measures. To be able to do that, and to be able to provide the best possible care as a nurse, a deeper understanding of patients experience of coercion is required.

Method: A descriptive literature review based on 13 scientific articles with a qualitative approach.

Main results: The results were presented in five categories and showed that many patients have similar experiences of compulsive care. Coercion was often described as the right measure to protect the patient or others, but many patients felt that it was performed incorrectly. Negative experiences mentioned were lack of information and communication, not being able to participate in their own care or being treated as a diagnosis by the staff. However, responsive, empathetic and helpful staff, adequate information on illness and treatment, the sense of participation and autonomy as well as a pleasant external environment and flexible rules were described as positive experiences and favorable to the recovery process.

Conclusion: Patients often described both good and bad experiences of compulsive care. In order to provide the best possible care, and to minimize the risk of coercive measures, it is important for the nurse to know and understand patients' experiences of compulsive care. Then the patients suffering can be reduced and their recovery can be promoted.

OBJECTIVE: The aim of this study was to investigate levels of perceived family cohesion during childhood, teenage years, and young adulthood in cancer-bereaved youths compared with non-bereaved peers.

METHODS: In this nationwide, population-based study, 622 (73%) young adults (aged 18-26) who had lost a parent to cancer 6 to 9 years previously, when they were teenagers (aged 13-16), and 330 (78%) non-bereaved peers from a matched random sample answered a study-specific questionnaire. Associations were assessed using multivariable logistic regression.

RESULTS: Compared with non-bereaved youths, the cancer-bereaved participants were more likely to report poor family cohesion during teenage years (odds ratio [OR] 1.6, 95% CI, 1.0-2.4, and 2.3, 95% CI, 1.5-3.5, for paternally and maternally bereaved youths, respectively). This was also seen in young adulthood among maternally bereaved participants (OR 2.5; 95% CI, 1.6-4.1), while there was no difference between paternally bereaved and non-bereaved youths. After controlling for a number of covariates (eg, year of birth, number of siblings, and depression), the adjusted ORs for poor family cohesion remained statistically significant. In a further analysis stratified for gender, this difference in perceived poor family cohesion was only noted in females.

CONCLUSION: Teenage loss of a parent to cancer was associated with perceived poor family cohesion during teenage years. This was also noted in young adulthood among the maternally bereaved. Females were more likely to report poor family cohesion. Our results indicate a need for increased awareness of family cohesion in bereaved-to-be families with teenage offspring, with special attention to gender roles.

The overall aim of this dissertation is to increase our understanding of what it is like to live as an unemployed young person, by looking at young people’s narratives. An additional aim is to explore and describe how unemployed young people’s experiences of participating in a support project can be understood from a caring science perspective. The overall questions addressed in the dissertation are: What does living in unemployment mean to a young person? How can a resource center for unemployed young people provide care? The dissertation includes a compilation of four scientific articles and an introductory chapter; it has a descriptive design and a hermeneutical approach. The dissertation starts from four meta-concepts used in caring science: human being, health, caring, and the world. These meta-concepts are the mainstays of the dissertation, at the same time as they give the research themes their caring science framework. The informants were 15 unemployed Finnish young men, aged 18-27 years, and 12 unemployed Finnish young women, aged 18-26 years. All had been out of work for between two and six months. The data were gathered by means of semi-structured interviews. The interviews were examined using content analysis and hermeneutic interpretation. To increase understanding of the dissertation’s themes as related to caring science, empirical results from the four studies were connected to elements of caring science theory taken from Katie Eriksson’s caritative caring theory. In summary, the results pertaining to the young men’s and women’s experiences of unemployment can be likened to a kind of suffering or weariness of life. Activities at the resource center for unemployed young people were characterized by Eriksson’s caring science concepts of tend, play and learn. Tending was revealed in how the young people were made to feel appreciated and accepted as the persons they were and are. The concepts play and learn were revealed in how the unemployed young people were given opportunities to express their dreams for the future and to dare to see other perspectives. At the resource center, positive caring powers could be identified – powers that worked together to enable the transition from suffering and weariness of life to a feeling of zest and the courage to face life. It can be established, in summary, that unemployment affects young people’s health. Not only for the unemployed individual, but also for society at large, it should be of great value to characterize the everyday life and reality of the unemployed at an early stage, and to move those who are suffering into a caring context in order to, if all goes well, replace weariness of life with the courage to face life.

7. Unemployment may increase feelings of lacking context in Life

Björklund, Ove

et al.

University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.

Häggström, Elisabeth

University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.

Purpose: Our aim was to describe Swedish Healthcare Direct (SHD) and its features as a complex system.

Methods: Qualitative interviews were conducted with 20 SHD telenurses, covering their experiences and skills when encountering and advising callers with mental illness. Complexity science was used as an a priori theoretical framework to enhance understanding of the complex nature of telenursing.

Results: SHD was described as a complex system as nurses were constantly interacting with other agents and agencies. During these interactions, dynamic processes were found between the agents in which the nurses adapted to every new situation. They were constantly aware of their impact on the care-seekers, and perceived their encounters with callers with psychiatric illness as "balancing on a thin line". SHD was also described as both an authority and a dumping ground. The openness of the system did not give the nurses possibility to control the number of incoming calls and the callers' intentions.

Conclusions: These new insights into SHD have important implications for organization developers and nursing management in terms of overcoming linear thinking.

BACKGROUND: Poor sleep, nausea, psychological distress, and a lowered quality of life are common during radiotherapy for cancer. There is a lack of studies on the relationship between radiotherapy-induced nausea and sleep. This longitudinal study analyzes data from 196 patients who underwent pelvic-abdominal radiotherapy for cancer.

OBJECTIVE: The aim of this study was to investigate sleep parameters weekly before, during, and after radiotherapy in relation to nausea and other patient characteristics, clinical characteristics, psychological distress, and quality of life.

RESULTS: Poor sleep was experienced by 30% of the participants, and sleep (quality and difficulty falling asleep) improved during and after treatment compared with baseline. Experiencing nausea during treatment was associated with worse sleep quality during radiotherapy. Baseline anxiety was associated with worse sleep quality before, during, and after treatment. Poor sleep was associated with worse quality of life.

CONCLUSION: Nausea, more than a number of other variables, is a possible predictor of poor sleep in patients during radiotherapy for cancer.

IMPLICATIONS FOR PRACTICE: The results indicate that effectively managing nausea may be important for sleep quality, and possibly quality of life, in patients undergoing radiotherapy for cancer. More research is needed before recommendations for practice can be made.

Background: In 2018, mental illness was the most common reason for inpatient care for men and women aged 15–44. What is central to a mental illness is that people who fall ill lose their normal perception of reality. The formation of a therapeutic relationship is a major part of the care of mentally ill patients and for such a relationship to arise, the treatment can be part of it. The nurse has a responsibility to care for patients and to have a good attitude towards care when mentally ill patients are vulnerable, this to make them more likely to dare to open up and be able to actively participate in the treatment.

Aim The aim of this study was to describe nurses’ experiences of what affects the interaction with a distorted perception of reality.

Method: A literature study with descriptive design.

Main result: The results showed that the response was affected by several aspects. Commitment, relationship building and organization affected the approach of patients with distorted perceptions of reality on different levels. Being there for the patients and being open in communication led to an improved relationship. Furthermore, the importance of having enough time and education is emphasized to communicate with these patients.

Conclusion: Attendance is a central part of psychiatric care. Training and competence in the workplace empowers nurses and gives them a good basis for meeting patients. An equal, open approach to patients strengthens the relationship between patient and nurse and provides the conditions for good care. Further development of nurses’ experiences can provide better conditions for nurses to treat and care for mentally ill patients.

Background: How patients preserve their sense of dignity in life is an important area of palliative care that remains to be explored. Aims: To describe patients' perspectives of what constitutes a dignified life within a palliative care context. Methods: Twelve palliative care patients were interviewed about their views on living with dignity. Data were analysed using qualitative content analysis. Results: What constitutes a dignified life during end-of-life care was captured by the theme 'I may be ill but I am still a human being' and presented under the categories 'preserving my everyday life and personhood', 'having my human value maintained by others through 'coherence' and 'being supported by society at large'. Conclusion: Patients' sense of dignity can be preserved by their own attitudes and behaviours, by others and through public support. Health professionals need to adopt a dignity-conserving approach, for which awareness of their own attitudes and behaviours is crucial.

BACKGROUND: In most parts of the world, nursing historically has been considered an occupation for women. Gender stereotypes are associated with the nursing profession.

AIM: The aim was to describe and compare the self-reported competence in female and male nursing students. The students were also compared according to their different background college educations. The theoretical framework of hegemonic masculinity and femininity was used.

DESIGN: A cross-sectional design with a questionnaire was used at two points in time, 2012 and 2017.

METHODS: Nursing students completed a questionnaire on graduation from a three-year university nursing program from 12 universities/university colleges in Sweden. In total, 1,810 students were participating, 1577 female and 227 male students. The Nurse Professional Competence scale was used for data collection.

RESULTS: There were statistical significant differences in the self-reported competence between female and male students (t-tests and ANOVAs). These differences are in agreement with the patterns of hegemonic masculinity and femininity. Female students estimated their competence in giving value-based nursing care as higher than male did. Male students estimated their competence in development and leadership higher than female did.

CONCLUSION: The pattern of hegemonic masculinity and femininity could be identified. This indicates a difference in power between female and male students.

IMPACT: The study addresses the self-reported competence of female and male nursing students. The results indicated that male students possibly looked on themselves as superior to the female students. In order to change the image of nursing as a woman's work, the self-images should be discussed in nursing education as well as in college education. Women interested in development, research and leadership and men interested in nursing care and administration must feel that nursing is a suitable profession for them. The stereotypical image of nursing as a women's work is a barrier to nurses' professional development.

The healthcare sector is fast-growing and knowledge-intensive, and to meet the demands associated with it, nursing students must have high levels of self-regulated learning (SRL), metacognition, and general self-efficacy (GSE). In this cross-sectional, correlational study, data were collected from 216 nursing students through a questionnaire. The aims were: 1) to describe the levels of SRL ability, metacognitive ability and GSE among second- and third-year nursing students; 2) to explore the relationships between the SRL ability, metacognitive ability and GSE of second- and third-year nursing students; 3) and to compare SRL ability, metacognitive ability and GSE between second- and third-year nursing students. Nursing students had moderate levels of SRL ability and metacognitive ability, but lower levels of GSE. Positive relationships between SRL ability, metacognitive ability, and GSE were observed. Third-year nursing students had a higher level of SRL ability but lower levels of GSE, compared to second-year students. In terms of metacognitive ability, no significant differences were observed between the student batches. Interventions are required for the improvement of nursing students’ SRL ability, metacognitive ability, and GSE.

Background: In the report from the CPR-register 8663 cardiac arrests were reported in Sweden in 2018 and 1482 successful resuscitations was performed. In the event of a cardiac arrest the brain is suffering from hypoxia and without adequate treatment the person may suffer permanent brain damage, or in worst case it could cause death. The nurse has responsibilities when it comes to care giving, and through increased understanding for peoples experiences of life after a cardiac arrest there is an opportunity to provide better individual treatment.

Aim: To describe people´s experiences after surviving a cardiac arrest.

Method: A literature study with a descriptive design and a thematic analysis method. 15 scientific articles with both qualitative and quantitative approach were retrieved from the databases MEDLINE through PubMed and CINAHL.

Result: The survivors often experienced loss of memory and cognitive difficulties after a cardiac arrest. Information and support from the care givers seemed to be important factors for the survivors so they could feel safe and secure. It also seemed that the physical abilities had deteriorated and going back to work was not obvious after acardiac arrest. Many of the personal roles were lost, and the survivors had a though experience adapting to a new identity. At the same time the survivors felt grateful that they had survived and many realized that they had a second chance of life.

Conclusion: To suffer from a cardiac arrest is a life changing event that often leaves thes urvivors with feelings of fear and anxiety but also with gratefulness that they had survived. There is an unintentional change of physical functions, roles and identity and this can be hard to handle for the survivors. Through individual treatment, the nurse may strengthen the survivors´ sense of coherence which leads to increased health of thesurvivors.

To describe the gardens and their use by individuals living at residential care facilities (RCFs) with high ratings on restorative values.

Background

Being outdoors has been described as important to older people's well‐being. Use of outdoor gardens may increase residents’ well‐being through experiences of restorative qualities such as being away and fascination. Thus far, there has been little research on restorative experiences of gardens in the care of older people.

Design

A descriptive design using behaviour mapping observations integrated with qualitative field notes and recorded conversations.

Methods

A criterion sampling of two gardens (out of a total of 87) was made based on residents’ ratings of restorative values; the two with the highest values were chosen. Eleven residents at the two RCFs took part. Data were collected through behaviour mapping observations, field notes and conversations on five occasions in the respective facilities during residents’ visits to the garden.

Results

The observations revealed that the main uses of the gardens were to socialise and relax. The conversations also showed that the garden stimulated residents’ senses and evoked memories from the past. These restorative values were interpreted as a sense of being away and fascination. Not having opportunities for outdoor visits was reported to result in disappointment and reduced well‐being.

Conclusions

The findings showed that two basic gardens with different characteristics and views could stimulate residents’ senses and evoke memories from the past; this supports the call for residents to be able to spend time in gardens to promote their well‐being.

Implications for practice

First‐line managers, nurses and healthcare staff in the care of older people should consider that regular opportunities to spend time outdoors may promote older people's well‐being through feelings of being away and fascination.

Currently, women comprise about ten percent of those sentenced to psychiatric forensic clinics in Sweden. Those who are sentenced to forensic care because of offending and violent behaviour have already taken a step away from the usually expected female behaviour. On the other hand, there are many women in forensic care who have not committed crimes, but who instead self-harm. Studies have identified a gender bias in diagnosing and care in psychiatric settings, but there are few studies conducted on women in forensic care. The present study therefore examined how the situation of women patients and female norms are expressed in the staff's talk about these women during verbal handovers and ward rounds at a forensic clinic in Sweden. The aim was to explore how psychiatric staff, in a context of verbal handovers and ward rounds, talk about women who have been committed to forensic psychiatric care, and what consequences this might have for the care of the patients. The content of speech was examined using audio recordings and a method of analysis that was inspired by thematic analysis. The analysis identified that the staff talked about the women in a way that indicates that they expected the women to follow the rules and take responsibility for their bodies in order to be regarded as acceptable patients.

Knowledge concerning nursing students’ experiences of the clinical learning environment and how supervision is carried out is largely lacking. This study compares nursing students’ perceptions of the clinical learning environment and supervision in two different supervision models: peer learning in student-dedicated units, with students working together in pairs and supervised by a “preceptor of the day” (model A), and traditional supervision, in which each student is assigned to a personal preceptor (model B).

Methods

The study was performed within the nursing programme at a university college in Sweden during students’ clinical placements (semesters 3 and 4) in medical and surgical departments at three different hospitals. Data was collected using the Clinical Learning Environment, Supervision and Nurse Teacher evaluation scale, CLES+T, an instrument tested for reliability and validity, and a second instrument developed for this study to obtain deeper information regarding how students experienced the organisation and content of the supervision. Independent t-tests were used for continuous variables, Mann-Whitney U-tests for ordinal variables, and the chi-square or Fischer’s exact tests for categorical variables.

Results

Overall, the students had positive experiences of the clinical learning environment and supervision in both supervision models. Students supervised in model A had more positive experiences of the cooperation and relationship between student, preceptor, and nurse teacher, and more often than students in model B felt that the ward had an explicit model for supervising students. Students in model A were more positive to having more than one preceptor and felt that this contributed to the assessment of their learning outcomes.

Conclusions

A good learning environment for students in clinical placements is dependent on an explicit structure for receiving students, a pedagogical atmosphere where staff take an interest in supervision of students and are easy to approach, and engagement among and collaboration between preceptors and nurse teachers. This study also indicates that supervision based on peer learning in student-dedicated rooms with many preceptors can be more satisfying for students than a model where each student is assigned to a single preceptor.

University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.

Strömberg, Annika

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.

Hagerman, Heidi

University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.

BACKGROUND: The importance of staff working life for staff well-being has been demonstrated in several studies; less research has focused on staff working life and older persons' satisfaction with care.

PURPOSE: The study aim was to study relationships between 1) staff assessments of their structural conditions/empowerment in elderly care, psychological empowerment, and job satisfaction and (2) older persons' satisfaction with care.

METHODS: A multilevel, cross-sectional, and correlational design was applied using questionnaire data on working life (1021 staff members) and unit-level data (40 elderly care units) on older persons' satisfaction with care.

RESULTS: Statistically significant relationships were found between all 3 working life variables and older persons' satisfaction with care. Furthermore, the results revealed an indirect/mediating effect of job satisfaction between structural empowerment and satisfaction with care, but not for psychological empowerment.

Aims and objectives. To describe the partners’ experiences of living with a person with chronic illness and how they manage everyday life.

Background. The number of partners providing informal care for their chronically ill spouse is rising, and they describe their daily life as demanding.

Design. A descriptive design with a qualitative approach was used.

Methods. A purposive sample of 16 partners with a chronically ill spouse were interviewed. The interviews were recorded, transcribed, and analyzed using qualitative content analysis.

Results Four main themes were identified: ‘Living with challenges caused by the spouse's disease,’ ‘Seeking support for living with the spouse’s illness,’ ‘Appreciating the good parts of life’ and ‘Adapting to constant changes and an uncertain future.’ The participants rated their health as rather good and had great confidence in their own ability to cope with daily life. Their experiences of support from formal care providers varied; they expressed the need for more assistance from the health care sector.

Conclusions. The partners experienced many challenges in everyday life when providing informal care for their chronically ill spouse. This affected both their physical and psychological health, as they had limited time for themselves. The partners seemed to receive more support from their informal network than from formal care providers. In handling daily life, the partners balanced demands and resources to identify possibilities to move forward and find meaning in life.

Owners’ ability to recognize signs of chronic pain in dogs undergoing pharmacologic and nonpharmacologic pain interventions during a period of physical rehabilitation is not known. This study aimed to compare dogs with and without chronic pain, and to assess the relationship between explanatory factors, including the probability of owners’ response bias induced by pharmacologic and nonpharmacologic pain intervention, and chronic pain in dogs with osteoarthritis (OA). Seventy-one dogs with OA were included in this observational study. Owner-perceived pain interference was measured by Canine Brief Pain Inventory (CBPI) and owner-perceived pain behavior was assessed using Helsinki Chronic Pain Index. A dichotomous variable of Helsinki Chronic Pain Index was used in regression analysis to investigate the association between chronic pain and explanatory factors (body condition, anti-inflammatory medication, animal physiotherapy consultation once or more and owners’ perception of pain interfering). Seventy-five percent of the dogs had ongoing anti-inflammatory medication, 51% of were overweight and 45% had a physiotherapy consultation. Higher levels of overt pain behaviors were reported in items addressing activities. Body condition, physiotherapy consultation and medication were not associated with chronic pain. Odds ratio (OR) and 95% confidence intervals of OR for the CBPI were 1.74 (1.23-2.47) and significantly associated with chronic pain. The adjusted OR of the CBPI did not differ from the crude OR. Owner-perceived pain behavior was not confounded by the dogs’ medication. Results indicated that CBPI was not mediated by the medication. The CBPI pain interference score was not associated with response bias and may be used as clinical outcome measure of chronic pain and pain-related disability in dogs with OA along a period of physical rehabilitation comprising pharmacologic and nonpharmacologic pain interventions.

To identify clusters based on graduating nursing students’ self‐reported professional competence and their achievement on a national examination. Furthermore, to describe and compare the identified clusters regarding sample characteristics, students’ perceptions of overall quality of the nursing programme and students’ general self‐efficacy.

Design

A cross‐sectional study combining survey data and results from a national examination.

Methods

Data were collected at two universities and one university college in Sweden in January 2017, including 179 students in the final term of the nursing programme. The study was based on the Nurse Professional Competence Scale, the General Self‐Efficacy scale and results from the National Clinical Final Examination. A Two‐Step Cluster Analysis was used to identify competence profiles, followed by comparative analyses between clusters.

Results

Three clusters were identified illustrating students’ different competence profiles. Students in Cluster 1 and 2 passed the examination, but differed in their self‐assessments of competence, rating themselves under and above the overall median value respectively. Students in Cluster 3 failed the examination but rated themselves at the overall median level or higher.

Conclusion

The study illustrates how nursing students’ self‐assessed competence might differ from competency assessed by examination, which is challenging for nursing education. Self‐evaluation is a key learning outcome and is, in the long run, essential to patient safety.

Impact

The study has identified clusters of students where some overestimate and others underestimate their competence. Students who assessed their competence low but passed the exam assessed their general self‐efficacy lower than other students. The findings illuminate the need for student‐centered strategies in nursing education, including elements of self‐assessment in relation to examination to make the students more aware of their clinical competence.

Abstract: Background: The most common cause of death for children aged 1-14 is childhood cancer. There is about a third who suffers from leukemia, a third who suffers from brain tumors and the last part constitutes the rest of the diagnoses. It is important to know how to respond parents 'thoughts and feelings about living with a child with cancer, since caregivers must individually the care of the child to their parents' needs. Aim: The aim of this study is to describe parents experience ́s to live with a child with cancer. Method: A literature study based on 11 articles with qualitative approach with the keywords: child, childhood cancer, cancer, family experiences, parents’ experiences and pediatric. The Cinahl database was used to search for articles. Main result: It has been consistent in the result that parents experienced anxiety, depression, anger and lack of sleep. Life is affected by parents after the children’s cancer diagnosis as there is a lack of everyday routines and normality. At a cancer diagnosis, the parents had a hard time seeing a future with the cancer sick child, which shows that the parents longing for the moment the child is cured. Conclusion: It became clear that parents of children with cancer experienced an initial need for support and the importance of getting the right information. Parents isolate themselves from their surroundings but can find other parents in the hospital with the same experience.

Aim: The aim of this thesis was to study the working life of first-line managers and their subordinates in elderly care from an empowerment perspective. Methods: Paper I and II used a qualitative approach, and semi-structured interviews were conducted with 14 male and 14 female first-line managers. Data were analyzed using qualitative content analysis. Paper III and IV used a quantitative approach with a longitudinal, correlational and multilevel design. 78 first-line managers and 1398 subordinates filled in the questionnaire at T1 and 56 first-line managers and 769 subordinates at T2. Data were analyzed using descriptive statistics, multivariate analyses (III &amp; IV) and multilevel modelling (IV). Results: In Paper I and II, the first-line managers reported having a challenging and complex work situation. Although the first-line managers sometimes expressed a need for better access to structural empowerment in terms of information, resources and support, they experienced psychological empowerment in their work. In Paper III, the results indicated that the more access the first-line managers had to structural empowerment over time, the more likely they were to feel psychologically empowered over time, resulting in lower ratings of their stress symptoms and higher ratings of their own self-rated leadership-management performance over time. Another finding in Paper III was the influence the number of subordinates per first-line manager had on the first-line managers’ ratings of structural empowerment and the subordinates’ ratings of structural empowerment and stress symptoms. In Paper IV, the results indicate that the more access the first-line managers had to structural empowerment at T1, the more access the subordinates had to structural empowerment at T2, and the higher the subordinates rated their first-line manager’s leadership-management performance at T2, when controlling for psychological empowerment. Conclusions: The working life of first-line managers in elderly care is complex and challenging, and they seem to need better access to structural empowerment (Paper I-IV). However, although deficiencies in access to structural empowerment were reported, the first-line managers experienced their work as a positive challenge (Paper 1) and felt that, though the work was not easy, it was worth it (Paper II).

27. How do first-line managers in elderly care experience their work situation from a structural and psychological empowerment perspective?

Hagerman, Heidi

et al.

University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.

The theme described the managers' work situation as "It's not easy, but it's worth it." In the four subthemes, the managers described their work in terms of "Enjoying a meaningful job," "A complex and demanding responsibility that allows great authority within set boundaries," "Supported by other persons, organisational preconditions and confidence in their own abilities" and "Lacking organisational preconditions, but developing strategies for dealing with the situations."

CONCLUSION:

The managers described having various amounts of access to structural empowerment and experienced a feeling of meaning, competence, self-determination and impact, that is, psychological empowerment in their work.

IMPLICATIONS FOR NURSING MANAGEMENT:

It is vital that first-line managers have access to organisational support. Therefore, upper management and first-line managers need to engage in continuous dialogue to customize the support given to each first-line manager.

Aim: The aim was to describe individuals’ experiences of living with long-term illness.

Methods: A qualitative approach with a descriptive design was used. Semi-structured interviews were conducted with 16 persons (50–80 years). They were also asked to self-rate their perceptions of their current health status and confidence in their ability to cope with everyday life.

Results: One main theme was identified: new insights and access to resources change the perspective on life. Personal characteristics and support from others were advantageous in finding ways to deal with limitations related to the illness. Most of the persons experienced a changed approach to life, in that they now valued life more than they had before. However, some persons also experienced lost values and found it difficult to accept medications. The persons rated their current health status as slightly above average, but their confidence in their ability to cope with everyday life as high.

BACKGROUND: Autonomy and participation are threatened within the group of older people living in nursing homes. Evidence suggests that healthcare personnel act on behalf of older people but are still excluding them from decision-making in everyday care.

OBJECTIVE: The purpose was to describe registered nurses' experience of caring for older people in nursing homes to promote autonomy and participation.

RESEARCH DESIGN: A descriptive design with a phenomenological approach was used. Data were collected by semi-structured individual interviews. Analysis was inspired by Giorgi's method. Participants and research context: A total of 13 registered nurses from 10 nursing homes participated. Ethical considerations: Ethical approval was obtained from the Regional Research Ethics Committee. Informed consent was achieved and confidentiality guaranteed.

FINDINGS: The essence of caring for older people in nursing homes to promote autonomy and participation consisted of registered nurses' awareness of older people's frailty and the impact of illness to support health and well-being, and awareness of acknowledgement in everyday life and trusting relationships. Paying attention to older people by being open to the persons' wishes were aspects that relied on registered nurses' trusting relationships with older people, their relatives and surrounding healthcare personnel. The awareness reflected challenges in caring to promote older people's right to autonomy and participation in nursing homes. Registered nurses' strategies, hopes for and/or concerns about development of everyday life in nursing homes were revealed and mirrored their engagement in caring for older people.

DISCUSSION AND CONCLUSION: Awareness of older people's frailty in nursing homes and the importance of maintained health and well-being were described as the main source for promoting autonomy and participation. Everyday life and care in nursing homes needs to be addressed from both older people's and healthcare personnel's perspectives, to promote autonomy and participation for residents in nursing homes.

Background: In 2018, 22,400 sexual offenses were reported in Sweden, of wich 96% of them were against women. The Council of Europe had started in 2014 and the Convention on the Prevention and Control of Violence against Women and Domestic Violence. At the same, the Swedish Higher Education Ordinance (SFS 2017: 857 and 2018: 1135) made a change and from 1 July 2018, it became a requirement for nures to have knowledge of women who are subjected to violence.

Purpose: The aim of this study was to describe nurse´s experiences of meeting abused women.

Method: A descriptive literature study. The result is based on 11 scientific articles which were reviewed and analyzed. The articles are both of quantitative and qualitative approach.

Main Results: Knowledge and guidelines are essential for nurses in providing care for sexually, mentally and physically abused women. If the nurses received adequate education, knowledge of resources in the hospital but also in society, it resulted in a safer care and environment for the women and the nurses, they felt mor secure in asking and talking about partner violence.

Conclusion: The nurse´s encounter with violent subjwomen aroused many strong feelings, and they were affected both during working hours and in private life. More training and knowledge in the subject are required for the nurses to be able to meet and care for women who are subjected to violence in a professional manner, which means more quality assured care.

Background: Complementary and alternative medicine (CAM) encompasses medical products and practices that are not a part of conventional treatment. CAM is based on a comprehensive view of the human and a holistic health. CAM treats everything - mind, body, spirit and beyond. Patients with cancer searching for hope and cure for their disease, some to be cured and some to live longer and improve their mental and physical well-being. Through self-care, the patient searches for CAM to find methods that are either a complement or alternative to the conventional treatment.

Aim: To describe patients with cancer experiences of complementary and alternative

medicine (CAM).

Method: Descriptive literature study with 12 included articles, all the included articles was qualitative. Data collection has been conducted via Cinahl and PubMed

Main result: Patients with cancer do often search for CAM to find a method that could extending life or make them feel better, for example relieve symptoms. The experience of the CAM-methods was mostly positive, the patients were helped with both physical and mental disorders. It turned out that healthcare workers attitude towards CAM was defective because of the lack of interest and knowledge.

Conclusion: Most of the patients reported positive experiences of CAM. Their sense of control and self-determination were higher than before the CAM-use. However, it appears that the patients experience a lack of support from the caregivers in the conventional medicine/healthcare when they, for an example, want to discuss CAM. It shows through a non-interest and a lack of knowledge of the methods.

Of all women, one in ten have endometriosis. The long-term illness affects women with symptoms such as pain. The quality of life of women is affected by delayed diagnosis. Personal experiences and attitudes of healthcare professionals can be decisive for how women perceive the treatment.

District nurses are preceptors of district nurse students at the postgraduate level. These district nurse students are already registered nurses who have graduated and are now studying to become district nurses; this training is at the postgraduate level. As preceptors at the postgraduate level, district nurses play an important role in helping these students to achieve the learning outcomes of the clinical practice part of their education. However, there is a lack of studies on precepting at this level. Thus, the aim was to describe district nurses' experiences of precepting district nurse students at the postgraduate level. The study was descriptive in design and used a qualitative approach. Purposive sampling was used and nine district nurses from seven primary health care units in Sweden were interviewed. Data were analysed using qualitative content analysis. An overall theme ”Fluctuating between transferring knowledge and striving for reflective learning” and two subthemes emerged. The preceptors’ views on precepting and performance varied depending on the situation. The conclusions is that given the current learning outcomes for clinical practice education at the postgraduate level, district nurses need to bemore influenced by preception focused on reflective learning.

Timely access to care services is crucial to support people with dementia and their family carers to live well. Carers of people with dementia (N = 390), recruited from eight countries, completed semi-structured interviews about their experiences of either accessing or not using formal care services over a 12-month period in the Access to Timely Formal Care (Actifcare) study. Participant responses were summarised using content analysis, categorised into clusters and frequencies were calculated. Less than half of the participants (42.3%) reported service use. Of those using services, 72.8 per cent reported timely access and of those not using services 67.2 per cent were satisfied with this situation. However, substantial minorities either reported access at the wrong time (27.2%), or feeling dissatisfied or mixed feelings about not accessing services (32.8%). Reasons for not using services included use not necessary yet, the carer provided support or refusal. Reasons given for using services included changes in the condition of the person with dementia, the service's ability to meet individual needs, not coping or the opportunity to access services arose. Facilitators and barriers to service use included whether participants experienced supportive professionals, the speed of the process, whether the general practitioner was helpful, participant's own proactive attitude and the quality of information received. To achieve timely support, simplified pathways to use of formal care services are needed.

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.

Mathiassen, Svend Erik

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.

Bengtsson, Lars

University of Gävle, Faculty of Engineering and Sustainable Development, Department of Industrial Management, Industrial Design and Mechanical Engineering, Industrial Management. University of Gävle, Center for Logistics and Innovative Production.

Engström, Maria

University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.

Purpose - The purpose of this paper is to 1) describe Lean maturity in primary care using a questionnaire based on Liker’s description of Lean, complemented with observations, and 2) determine the extent to which Lean maturity is associated with quality of care measured as staff-rated satisfaction with care and adherence to national guidelines. High Lean maturity indicates adoption of all Lean principles throughout the organization and by all staff.

Design/methodology/approach - Data were collected using a survey based on Liker’s four principles, divided into 16 items (n = 298 staff in 45 units). Complementary observations (n = 28 staff) were carried out at four units.

Findings - Lean maturity varied both between and within units. The highest Lean maturity was found for ‘adhering to routines’ and the lowest for ‘having a change agent at the unit’. Lean maturity was positively associated with satisfaction with care and with adherence to national guidelines to improve healthcare quality.

Practical implications - Quality of primary care may benefit from increasing Lean maturity. When implementing Lean, managers could benefit from measuring and adopting Lean maturity repeatedly, addressing all Liker’s principles and using the results as guidance for further development.

Originality/value - This is one of the first studies to evaluate Lean maturity in primary care, addressing all Liker’s principles from the perspective of quality of care. The results suggest that repeated actions based on evaluations of Lean maturity may help to improve quality of care.

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.

Bengtsson, Lars

University of Gävle, Faculty of Engineering and Sustainable Development, Department of Industrial Management, Industrial Design and Mechanical Engineering, Industrial Management. University of Gävle, Center for Logistics and Innovative Production.

Mathiassen, Svend Erik

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.

Högberg, Hans

University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.

Engström, Maria

University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.

Lean is commonly adopted in healthcare to increase quality of care and efficiency. Few studies of Lean involve staff-related outcomes, and few have a longitudinal design. Thus, the aim was to examine the extent to which changes over time in Lean maturity are associated with changes over time in care-giving, thriving and exhaustion, as perceived by staff, with a particular emphasis on the extent to which job demands and job resources, as perceived by staff, have a moderated mediation effect.

Method

A longitudinal study with a correlational design was used. In total, 260 staff at 46 primary care units responded to a web survey in 2015 and 2016. All variables in the study were measured using staff ratings. Ratings of Lean maturity reflect participants’ judgements regarding the entire unit; ratings of care-giving, thriving, exhaustion and job demands and resources reflect participants’ judgements regarding their own situation.

Results

First, over time, increased Lean maturity was associated with increased staff satisfaction with their care-giving and increased thriving, mediated by increased job resources. Second, over time, increased Lean maturity was associated with decreased staff exhaustion, mediated by decreased job demands. No evidence was found showing that job demands and job resources had a moderated mediation effect.

Conclusion

The results indicate that primary care staff may benefit from working in organizations characterized by high levels of Lean maturity and that caregiving may also be improved as perceived by staff.

This paper reports on qualitative data from the Actifcare study investigating experiences, attitudes, barriers and facilitators concerning access to and use of formal care. A total of 85 semi-structured in-depth interviews were conducted in eight European countries. Results were analysed with a deductive content analysis, first within country and then integrated in a cross-national analysis. Overall, analysis of the in-depth interviews revealed two major themes with five subcategories. The results can be summarised in an optimal pathway for access to dementia care. This pathway includes fixed factors such as disease-related factors and system-related factors. In addition there are personal factors that are subject to change such as attitudes towards care. An important finding consisted of the necessity of having sufficient information about the disease and available care and having a key contact person to guide you through the process of finding suitable care while monitoring your needs. In addition, it is important to involve your social network as they can take on care-giving tasks. It is helpful to have a diagnosis (in most countries). Concerning decision-making, the person closest to the person with dementia is in the majority of cases the one who makes the ultimate decision to access and use services and he/she should therefore be supported in this process. These results provide insight into the factors that influence the pathway to formal care use and help professionals to enhance access to formal dementia care by focusing on factors that can be modified.

Objective: The increased attempted suicide rate is one of the main problems healthcare systems face in many societies. Social meaning is one of the main fields of studying suicide attempts. The main aim of the present study was to investigate the motives of suicide attempts among Iranian women.

Method: To explore suicide motives, history of medical or psychological issues, family relationships, and environmental conditions, participants were interviewed individually. The present study comprised semi-structured interviews involving 52 women who had attempted suicide and subsequently been hospitalised. Finally, the data were transcribed, categorised and narrated.

Results: The study identified two types of suicide meanings: escape and appeal. Escape suicide attempts were motivated by a desire to run away from intolerable situations in the family or social life. Escape suicide attempts were characterised by flight from grief, loss of honour, shame, infamy or memories of failure incidents. In appeal suicide attempts, participants experienced high pressure or control from husbands or other heads of families and the suicide attempts were used as a strong request to make her husband or family change. Other participants attempted suicide when their honours or masteries were threatened, or when they had committed deeds associated with great shame. The results also showed that several participants provided clear examples of patriarchic oppression as a strong underlying mechanism for suicide motivation.

Conclusions: As the results of our study revealed that family and gender structures play integral roles in motives of suicide attempts, future research among Iranian men is suggested.

Objectives: Previous research found that burdens are put on relatives to patients with serious mental illness. A majority of the studies have described the situation of being a husband/wife or parent of someone who is mentally ill. However, little is known about the perspective of childhood experiences and the effect on adult life from having a parent with mental illness. Hence, the purpose of this review was to investigate experiences of having a parent with serious mental illness.

Methods: We used a qualitative interpretive meta-synthesis. Five relevant databases were chosen: Cumulative Index to Nursing and Allied Health Literature, MEDLINE, PsycINFO, PubMed and Psychology and Behavioral Sciences Collection. We found 4302 studies in our initial search. Fourteen met the inclusion criteria and the quality assessment.

Results: The findings are presented in four themes: (1) Growing up in a dysfunctional home environment; (2) The child’s feelings and thoughts; (3) The need of support; and (4) The lingering effects in adult life.

Conclusions: We found that experiences of growing up in a dysfunctional home can result in relational issues later in life and that the need for support can persist into adult life. This has implications for clinical practice when encountering these patients.

The aim of the study was to describe nursing students' reflections on caring for end-of-life patients in a youth volunteer service. A purposive sample of 11 nursing students in one province in China were interviewed and diaries were collected. The data were analysed using qualitative content analysis. The students described the service as “an empowering care that makes a difference – but not without challenges on different levels”. The service was said to provide devoted caring adjusted to the person's need, condition and wishes. According to the students, the service had an impact on them; the internal and/or external support was stimulating and rewarding, whereas deficient support was frustrating and made them feel helpless. They emphasized the need for improvements at different levels. In conclusions, the youth volunteer service empowers both patients and students and can be seen as person-centred care. The students' professional knowledge, skills and ability improved, while these aspects were still perceived as deficient. Appropriate curriculum and training for nursing students are necessary and should be tailored to improving students' caring ability and confidence. Expanding the service was emphasized and suggestions for improvements were identified.

Background: Transgender and non-binary people are a stigmatized group within the society. Members of this group often experience a deep sense of exclusion, and are statistically over-representeded in mental healthcare. However, there is a lack of knowledge about how nurses providing care in these situations should appropriately behave and interact in meetings with transgender and non-binary people in healthcare.

Aim: The purpose of this study was to describe the lived experiences of transgender and non-binary people in meetings with healthcare providers.

Method: The study is based on a literature review with a descriptive design. Literature searches identified ten qualitative studies that met the study’s inclusion criteria. Findings from an analysis of the relevant literature are grouped into two overarching themes and seven further sub-themes.

Main results: The findings of this study showed that the majority of transgender and non-binary people have experienced, on at least one occasion, being met with ignorance in healthcare situations. Those self-identifying as non-binary often reported feeling as though they are required to fit into categories they are uncomfortable with. Evidence also suggests that the kind of language used by healthcare providers played an important determining role in how meetings were experienced by transgender and non-binary people. Use of appropriate pronouns and terminology by staff appears to help make feel more accepted.

Conclusion: Due to the widespread lack of knowledge, healthcare providers often found it difficult to know how to behave and interact in meetings with transgender and non-binary people. Problems rooted in the lack of understanding contributed to negatively affect people’s experience with the healthcare system. Therefore education about transgender and non-binary people should be more available for healthcare-providers

University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science. Centre for research and Development, Uppsala University, Gävle. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.

Carlsson, Marianne

University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala; Sweden.

Engström, Maria

University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.

The shortage of registered nurses is a global concern. Motives to become registered nurses can be to help others, altruism, personal development and career security. Motives in combination with student expectations regarding the role are not explored.

Objective

To describe students' motives to become registered nurses and their expectations regarding their future profession.

Design

A longitudinal descriptive design with a qualitative approach was used to follow nursing students in the beginning, during and at the end of their education.

Participants and setting

A purposive sampling of a group with initially 75 students starting a three-year nursing program at a university in Sweden.

Methods

A study specific questionnaire with open-ended questions was used in the beginning, during and the end of the students' education. At data collection two and three, a copy of the earlier answers was attached. Data were analysed using manifest and latent content analysis.

Results

An important profession with career opportunities, interesting duties and team work were described. Students expected diversified duties, possibilities for development and work satisfaction. Increased concerns regarding their upcoming work life was described at the end of the education.

Conclusion

The students had a positive understanding of the profession and perceived their forthcoming role as interesting. The leading role of coordinating patient care was more comprehensive than expected. Supportive conditions and well planned transition periods could strengthen newly graduated nurses in their professional role and could be an important aspect in the future retention of RNs.

Aim: To explore the perceptions of infection control practices among healthcare personnel and evaluate the use of authentic vignettes as a means to alter infection control behavior.

Method: Four authentic vignettes were used as a part of reflective dialogues with healthcare personnel. An evaluation of the dialogues was performed with six healthcare personnel using the focus group technique. Qualitative content analysis was used to analyze the data.

Results: The mind-set to help one another and do one’s best in every situation was described as a core aspect in preventing the transmission of microorganisms. Having support, taking personal responsibility, being knowledgeable about infection control practices, and having a reasonable workload were seen to play decisive roles in controlling the spread of infection. Discussing authentic comprehensible vignettes with colleagues during the allotted time was considered a valuable method for improving infection control practices.

Conclusion: Meaningful insights on how best to use vignettes as a means to improve infection control practice were gained. These findings should be considered when designing theory-driven interventions in different contexts, which are aimed at improving infection control practices in health care.

Background: Cancer is a disease that affects a lot of people. A third of the Swedish population is estimated to be affected of the disease. The cancer treatment has evolved and more and more of the affected people survive, on the other hand the treatment is aggressive and gives side effects where altered nutrition is one of them. For a good health, a good nutrition is necessary. When there is a lack of nutrition the individual’s immune system is affected, the risk for diseases increases and the wellbeing of a person decreases. A person’s wellbeing is a requirement for quality of life.

Aim: The aim was to describe experiences of the importance of nutrition for the health of people with cancer.

Method: A descriptive review that identified 12 studies through the database MEDLINE through PubMed. The literature study builds on a thematic analysis.

Results: in the present result it occurs that people with cancer get nutrition related problems (NRP) in connection with the treatment. Which creates a problem with a good nutrition intake. The altered situation gives negative emotions and limits the individual socially. A basis to handle NRP and preserve the health is to find self-care strategies.

Conclusion: Nutrition related problems are common on people with cancer and causing straining physically, psychological and socially. The nurse has an important role to pay attention to individual needs of people with cancer and adapt the care to the individual. It is significant from a care perspective to motivate people to self-care strategies to promote health.

50. Lecturers' reflection on the three-part assessment discussions with students and preceptors during clinical practice education

Löfmark, Anna

et al.

University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science. Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Norway.

Mårtensson, Gunilla

University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science. Department of Public Health and Caring Sciences, Uppsala University, Sweden.

Ugland Vae, Karen Johanne

Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Norway.

Assessment of students' learning and achievement requires active involvement of participating students, preceptors and lecturers. The lecturers have overall responsibility for both the content of the assessment and students' learning. The aim of the present study was to investigate lecturers' reflections on the mid-course discussion and final assessment that are part of nursing students' clinical practice education. The design was descriptive and had a qualitative approach. Repeated group discussions were undertaken with 14 lecturers at two university campuses in Norway. Five categories were identified: preparing for the three-part discussion, creating a collaborative atmosphere, facilitating student learning, verifying student learning, using the assessment tool to create the assessment discussion; one theme emerged: ‘being able to see and justify students’ learning processes'. Lecturers' reflections on both assessment discussions and students' learning proceeded from a clear pedagogical viewpoint.